104例成人急性白血病生存分析

目的 总结成人急性白血病患者的预后因素。方法 对我院3年来104例治疗和随访的成人急性白血病患者，采用对数秩检验(Logrank)和比例危险率(COX)回归模型分析其预后因素。结果 104例患者中有15例达5年以上长期生存，总的5年长期生存率为14．4％，急性髓细胞白血病(AML)为18．6％，急性淋巴细胞白血病(ALL)为1.8％，确诊后第1年病死率高；急性早幼粒细胞白血病(M3)的长期生存率较其他类型高。第1次化疗诱导缓解、骨髓移植、乳酸脱氢酶(LDH)正常的患者生存时间较长，核型结构或数目异常组生存概率均低于正常棱型组。结论 成人急性白血病5年长期生存率为14．4％，M3预后较好，第1次诱导是否缓解及是否骨髓移植是影响长期生存的主要预后因素，LDH可考虑作为急性白血病(AL)疗效及预后判断的一项参考指标，核型分析在AL中具有独立于其他临床指标的预后意义。

Survival analysis on 104 cases of adult acute leukemia

Objective To sum up the prognostic factors in adult acute leukemia in our hospital.Methods 104 adult acute leukemia patients in our hospital for three years were reviewed and followed up.Survival analysis (Logrank test and COX regression model) was used to analyse the prognostic factors.Results 15 patients had 5 year long term survival,the rate was 14.4% for all the cases,being 18.6% for acute myeloid leukemia and 1.8% for acute lymphocytic leukemia whose low survival rate occurred in the first year after diagnosis.Long term survival of acute progranulocytic leukemia was higher than that of other types.The median survival time was longer in the group with first regiment achieving complete remisson or bone marrow transplantation or normal lactic dehydrogenase(LDH).The over all survival in patients with structrural or qualitative abnormalities was lower than that in patients with normal karyotype.Conclusion The 5 year long term survival rate for acute leukemia was 14.4% , acute progranulocytic leukemia had better prognosis.Complete remission by the first regiment and bone marrow transplantation were highly associated with long term survival.LDH was helpful in guiding therapy and judging the prognosis.Karyotype was of importance for the prognosis of acute leukemia comparing to others.